Nipple stimulation for how long to induce labor

Several mechanisms underlie the onset of labor, which appears to be associated with different plural factors. In particular, the underlying mechanism of breast simulation inducing the onset of labor is considered to be associated with the OT level. In the s, the most frequently investigated procedure for the contraction stress test CST was the induction of OT release by breast stimulation in pregnancy instead of the use of synthetic OT. CST is an examination method for determining the coping ability of the fetus with uterine contractions mainly for high-risk pregnancies.

It is one of the antepartum fetal surveillance assessment techniques. Amico et al. On the other hand, Ross et al. Thus far, the results obtained remain controversial, and little has been reported about OT levels following breast stimulation for 3 days to promote spontaneous onset of labor. The objectives of this preliminary study were to 1 determine the changes in the salivary OT level during breast stimulation for promoting the spontaneous onset of labor in low-risk term pregnancies, and 2 clarify the feasibility of the breast stimulation intervention protocol used in terms of its practicality and acceptability.

This trial used a quasi-experimental single-arm time series design. This research was a feasibility study. The sample size was based on previous research reporting on saliva OT level from 11 breastfeeding women [ 19 ].

Previous studies reporting on plasma OT level in pregnant women involved about 10 to 20 subjects [ 17 , 18 , 20 — 22 ]. The eligibility criteria were as follows: planned to give singleton birth by spontaneous cephalic delivery; between 38 and 40 weeks of gestation; Asian and can read and write Japanese; received permission from the obstetrician or midwife to participate.

A flowchart demonstrating the recruitment of the study participants is shown in Fig 1. When eligible pregnant women at 34 weeks of gestation visited the outpatient ward for a prenatal check-up, we verbally explained our research in a place without a nurse or an obstetrician. After obtaining consent, we decided with the participant the first intervention day after 38 weeks of gestation. Women also received a refusal form at that time with an explanation that they can withdraw any time without any disadvantage.

In the data collection facility of this study, pelvic examination is performed for all pregnant women after the 37 weeks check-up. Membrane sweeping may be performed at the discretion of an obstetrician after 39 gestational weeks. The experiments were held in the hospital for 3 consecutive days.

There were some subjects who had perinatal check-ups by obstetricians before and after the experiment. Data were collected at a single maternity hospital in Kanagawa, Japan between June and August The study protocol was approved by the Institutional Review Board of St.

The breast stimulation intervention time was 3 days. The same time of the day was used to control for diurnal effects. Saliva was collected within the period from to hrs. The participants were asked to refrain from sexual intercourse and drinking alcohol before the day of intervention.

They were also instructed to finish their meal, brush their teeth, and not to smoke 1 hour before the intervention. They were also asked not to use a lipstick. The experiment was started 30 minutes after the intake of mL of water.

At the start of the study, the cervix score was evaluated for cervical ripening Fig 2 ; cervical check using a modified Bishop Score. Cervical ripening can be a possible option for evaluating the intervention in relation to the endpoint. The evaluators were composed of 3 midwives who have 10 years of experience to standardize the assessment. The participants performed breast stimulation for 3 days together with an attendant midwife in the hospital.

To standardize the intervention technique, a midwife demonstrated how to perform breast stimulation for 10 minutes using a breast model prepared from wool and a pressure-measuring instrument Perineometer, OWOMED, Gyeonggido, South Korea.

The recommended stimulation pressure was between 20 and 50 mmHg, which is a gentle pressure and does not damage the nipple. To achieve a stimulation rhythm of 69 beats per minute, a lighting electric metronome SQ50V, Seiko Watch Corporation, Tokyo, Japan without a sound was used as guide. Each breast was stimulated for 15 minutes, beginning on the right, alternating between the breasts to prevent uterine hyperstimulation, for a total of 1 hour per day.

Breast stimulation was performed by pinching the breast to a degree that did not hurt starting from the outer areola to the nipple using the thumb, forefinger, and middle finger. Direct self-stimulation of the breast was performed using either the left or right hand with Pure Horse Oil Sonbahyu; Yakushido, Fukuoka, Japan. To address concerns or worries regarding the presence of others during breast stimulation, a nursing cover was used. We managed the time and notified the participants.

Cardiotocography CTG readings were obtained during the intervention to record uterine activity and check the fetal heart rate. Adequate uterine contraction was defined as having at least 3 contractions lasting for 40 seconds each occurring within 10 minutes.

The frequency of uterine contraction can also be a possible option for evaluating the intervention in relation to the endpoint. The participants watched a prepared movie i. After the intervention, the participants answered a questionnaire on the feasibility of the experimental intervention.

Cervical ripening was reassessed at the end of the intervention. The intervention was performed by 3 midwives consisting of the first author and 2 research assistants. They had adequate CTG reading ability gained from their more than 5 years of clinical experience and over cases of conducting labor management for this feasibility study.

For the intervention standardization, the explanations for the participants and intervention details were unified. Moreover, the first author consistently participated in the experiments twice at the beginning to ensure that the research assistants can properly implement the intervention procedure. Research assistant A was responsible for Salivary assays are relatively easy to perform and are minimally invasive for pregnant women.

Saliva samples were collected 10 minutes before and 15, 30, 60, 75, and 90 minutes after the breast stimulation intervention for a total of 18 samples per participant. To standardize the saliva collection procedure, the participants were asked to pool their saliva in their mouths for 3 minutes.

Afterwards, the participants collected about 1. If this volume could not be collected after 3 minutes, the participants repeated the saliva collection procedure. OT level was assayed using the method of Carter et al. OT receptor single nucleotide polymorphism has been reported to reduce sensitivity to OT [ 28 , 29 ]. In particular, women with GG homozygous types at OT receptor gene rs reportedly transitioned to late active labor.

In the present study, buccal mucosa samples were obtained for the analysis of 3 OT receptor gene polymorphisms i. We evaluated the feasibility of the breast stimulation intervention protocol in terms of practicality and acceptability [ 30 ].

For the practicality of the experimental method , the proportion of analyzable samples and the occurrence of adverse events were considered. For the acceptability of the experimental method , the dropout rate after the intervention was considered. The visual analog scale VAS , which is one of the most valid, reliable, and frequently used measurement tools for a self-report measure, was used in the present study to rate fatigue [ 31 ] and pain [ 32 ].

Considering the cultural background of East Asians tending to choose the midpoint [ 33 , 34 ], a 4-level Likert scale was used for the measurement of attitude to avoid ambiguity for these questions.

In addition, the participants responded to questions about the environment where the intervention was carried out. The means M , standard deviations SD , standard errors SE , and medians of all variables were calculated. We employed a linear mixed model using the AR 1 covariance structure with the OT level as the dependent variable and the day and time of intervention as the fixed effects.

The main cause of the missing data was insufficient saliva volume and not missing data due to the OT value, thus the missing data in this study reflected missing completely at random MCAR. Five imputed datasets were created. The data had a non-normal distribution. Written informed consent to participate in the study and publish the results was initially obtained from 34 pregnant women.

Finally, 16 low-risk pregnant women mean age, 29 years; SD , 2. Oxytocin also increases the production of hormones called prostaglandins , which further increases contractions. The synthetic version of oxytocin, Pitocin, is frequently administered to pregnant people to induce or help progress the labor process. The increase in oxytocin from nipple stimulation can cause contractions that may kick start labor if the pregnant person's body is prepared to give birth.

Medical induction of labor is usually done when there is a need for it but can be done electively in certain situations. This may include:. Inductions for these purposes are performed by healthcare professionals and usually involve medication or medical procedures. In some cases, such as a pregnancy that is past its due date but is not yet post-term, trying nonmedical ways to induce labor such as nipple stimulation may be recommended by the healthcare provider before doing a medical induction.

There isn't a definitive answer as to whether nipple stimulation is effective for inducing labor. There aren't a lot of studies on the subject, and the ones that do exist have low sample sizes, are not extensive, and are out of date. It is also difficult to measure the effectiveness of natural induction methods because they are performed when a person is full-term and they may have given birth whether or not they had tried to start labor using these methods.

A study found that nipple stimulation appeared to shorten the length of labor and decrease the instances of cesarean sections. The study involved pregnant participants and divided the participants into three groups:. Despite inconclusive evidence, many healthcare providers recommend it as an option for their clients who are full-term. Ninety-two percent of the respondents named labor augmentation as their reason for suggesting nipple stimulation.

Most healthcare providers agree that nipple stimulation only has the potential to be effective if the pregnant person's body is ready to give birth. Indications of this include:. During a healthy, uncomplicated pregnancy, nipple stimulation is unlikely to cause premature labor or miscarriage. In fact, many people choose to breastfeed another child while pregnant.

While oxytocin is released with breast stimulation, in an uncomplicated pregnancy, the uterus only becomes sensitive to it when close to labor.

Breast or nipple stimulation is not advised during pregnancy if:. Using nipple stimulation to try to induce labor in a full-term, healthy pregnancy is generally considered safe. There is, however, a possible risk of uterine hyperstimulation when contractions come too close together , which could cause fetal distress.

This risk is low with nipple stimulation and seen more often in medical inductions, but because of the potential for fetal distress, many experts recommend doing nipple stimulation under the supervision of a healthcare provider who can monitor the baby and parent. Before trying nipple stimulation to induce labor, make sure:. No studies have been performed on the safety or efficacy of nipple stimulation to induce labor in people with high-risk pregnancies.

Always check with a healthcare provider before trying any method of labor induction. Call your healthcare provider or go to the hospital if you experience any of the following either before, during, or after trying natural induction methods:. There are a few different ways to do nipple stimulation with the intent of labor induction. The goal is to mimic a nursing baby. This technique is similar to hand-expressing breast milk when breastfeeding.

Similar to manual nipple stimulation, a breast pump mimics a nursing baby and can help with the release of oxytocin. Pumping may extract colostrum from the breast—this is not a concern. There is no universally agreed-upon pattern for nipple stimulation, but one pattern that is recommended for either manual stimulation or pumping is:. If the doctor thinks that it is necessary to induce the birth, they can admit the woman to the hospital and prescribe medications to stimulate uterine contractions and labor.

Medications may include Pitocin, which is a synthetic version of oxytocin. However, doctors prefer not to use these methods unless they are medically necessary. A look at nipple fissures, cracks in the skin of the nipple and areola. Included is detail on the prevention, and how they are related to pregnancy. A look at third sometimes called supernumerary nipples, a relatively common condition where an individual has an extra nipple.

Included here are…. What are the recommendations for how long women should wait before resuming sex after pregnancy? How does giving birth affect sex? Factors influencing…. Most deliveries happen safely, but sometime a complication can occur. Common problems include failure to progress, excessive bleeding, and placenta…. However, this is not always the case, and…. Use your fingers or palm to gently rub your nipple and areola through thin clothing or directly on the skin.

You can also use an oil or lubricant on your nipple to make it more comfortable. It is possible to get too much of a good thing. Follow these guidelines to prevent overstimulation:. Always speak with your doctor or midwife before using nipple stimulation to induce labor. You can also use nipple stimulation in combination with other natural labor-inducing techniques.

In the early stages of labor, these contractions may feel like dull pressure or mild discomfort in the lower part of your belly, your low back, or in your pelvis. Time a few of your contractions as soon as you notice them so that you can communicate the information with your healthcare team. In the early stages, contractions may be 5 to 20 minutes apart and last around 30 to 60 seconds.

If your water breaks before contractions begin, call your doctor or midwife to find out the next steps. Also let your care professional know if you experience any bleeding. Otherwise, you might consider heading to the hospital or birth center when your contractions have been just 5 minutes apart for over an hour. Nipple stimulation is an effective way to induce labor, backed by scientific research. Massaging the nipples releases the hormone oxytocin in the body.

This helps initiate labor and makes contractions longer and stronger. Speak with your doctor or midwife about whether nipple stimulation is safe for you to try.

The final stages of pregnancy can be a trying time. You may be uncomfortable, exhausted, and anxious to meet your baby. Speak with your doctor or midwife about what actions might be safe for you to try. And remember that babies generally are healthier and do better when they reach at least 39 weeks of gestation before being born.